ABSTRACT
BACKGROUND: The Perioperative Surgical Home is a novel care model designed to provide patient-centered, high-quality surgical care. In 2013, we implemented POSH, a pilot Peri-Operative Surgical Home at Phoenix Indian Medical Center (PIMC), an Indian Health Service hospital, as a quality improvement project. After 2 y, we sought to quantify the impact of POSH on the quality of surgical care at PIMC. MATERIALS AND METHODS: We conducted a retrospective review of 33 surgical patients who underwent surgery at PIMC through the POSH process between 2013 and 2015 matched to 64 historical controls with similar operations. Study patients underwent surgery via the POSH treatment process. Primary outcomes were composite measures of (1) care standards and (2) care goals. Success was defined as meeting seven of nine care standards and six of eight care goals. RESULTS AND DISCUSSION: The mean number of care standards met was 8.1 ± 1.0 versus 4.2 ± 1.4 (P < 0.001) and the mean number of care goals met was 6.7 ± 0.8 versus 6.1 ± 1.1 (P = 0.005) for POSH patients and historical controls, respectively. Patients participating in the POSH model were 8.6 (95% confidence interval: 3.5-22.3) and 1.5 (95% confidence interval: 1.2-1.9) times more likely to meet the minimum number of care standards and goals, respectively. Fourteen of the study patients (42%) would not have been offered surgery at PIMC before POSH due to elevated surgical risk. CONCLUSIONS: POSH may have improved quality of surgical care at PIMC while expanding services to more complex patients. POSH may present an opportunity for improved surgical quality in resource-constrained environments.
Subject(s)
Health Services, Indigenous/organization & administration , Indians, North American , Patient Care Team/organization & administration , Patient-Centered Care/organization & administration , Perioperative Care/standards , Quality Improvement/organization & administration , Surgeons/organization & administration , Adult , Aged , Arizona , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Perioperative Care/methods , Perioperative Care/statistics & numerical data , Pilot Projects , Quality Improvement/statistics & numerical data , Retrospective StudiesABSTRACT
Physicians should be aware of the advantages and disadvantages of each antiretroviral class and be aware of patients' lifestyles when choosing an individualized regimen.
